眼眶泪腺癌26例的CT诊断价值

目的：探讨泪腺腺癌的CT诊断价值。 方法：回顾性分析26例26眼经病理证实眼眶泪腺腺癌患者的CT影像资料。 结果：泪腺腺癌26例均为单眼发病,右眼15例,左眼11例。CT表现：病变呈圆形、卵圆形15例,不规则形、分叶形11例。15例边界尚清楚,11例轮廓呈锯齿状。肿瘤密度不均匀,内见低密度灶或钙化。26例病变包绕并压迫眼球,14例沿眶外壁向眶尖区生长,与眼肌分界不清,并浸润视神经。眼眶骨质虫蚀样破坏21例,溶骨性破坏5例。 结论：泪腺癌有特异性CT征象,其诊断准确率高,是本病最主要影像检查方法。     

泪腺炎症及淋巴细胞增生性病变的CT及磁共振成像诊断

目的研究泪腺炎症及淋巴细胞增生性病变的CT和MRI表现及其诊断价值。设计回顾性病例系列。研究对象泪腺炎症及淋巴细胞增生性病变患者46例。方法回顾分析46例经病理学或临床证实的泪腺炎症及淋巴细胞增生性病变患者的CT及MRI影像资料。主要指标病变形态、信号(密度)、累及范围。结果46例患者中炎性假瘤32例,表现为泪腺体积增大,CT示泪腺呈均匀等密度,MRI T_1WI及T_2WI呈等或低信号,1例可见多发囊变,MRI增强扫描病变强化明显。Mikulicz病4例,均为双侧泪腺弥漫增大,CT呈均匀等密度,MRI T_1WI及T_2WI均呈低信号,增强后呈明显均匀强化。反应性淋巴细胞增生5例,表现为泪腺体积增大,CT呈均匀等密度,MRI T_1WI、T_2WI呈低或等信号,1例T_2WI呈高信号,增强扫描呈明显强化。非典型性淋巴细胞增生1例,CT表现为双侧泪腺弥漫性增大,密度均匀。泪腺淋巴瘤4例(B细胞淋巴瘤3例,组织细胞肉瘤1例),表现为双侧泪腺弥漫性增大。结论泪腺炎症及淋巴细胞增生性病变的影像表现相似,CT及MRI有助于病灶与泪腺上皮性肿瘤的鉴别,并可准确显示病变累及范围。(眼科,2007,16:308-311)     

CT重建测量眶内段视神经的重复性研究

目的 评价采用多层螺旋CT视神经曲面重建的方法,测量成人眶内段视神经鞘横断面直径和面积的可行性和可重复性.方法 选取正常成人55例,用多层螺旋CT行头颅容积扫描,获取图像经图像后处理工作站进行眶内段视神经的曲面重建,检测参数为距球后视神经起始部3、6、9、12、15 mm处视神经鞘横断面的直径和面积.同一检测者在3次非连续性时间盲法测量,计算组内相关系数（intraclass correlation coefficient,ICC）、组内变异系数（within-subject coefficient of variation,CVw）评价该方法的可重复性.结果 距球后视神经起始部3、6、9、12、15 mm处,视神经鞘横断面直径最大值的ICC和CVw范围分别为0.902 ～0.941和2.99％ ～4.50％,其直径最小值的ICC和CVw范围分别为0.902 ～0.943和3.54％ ～4.74％,视神经鞘横断面面积的ICC和CVw范围分别为0.932～0.957和5.77％ ～7.37％,其中距球后视神经起始部3 mm处视神经鞘横断面面积测量值的ICC最高为0.957.结论 采用CT重建测量眶内段视神经横断面结构的方法可重复性好,距球后视神经起始部3 mm处检测参数的重复性最高.此方法对眼眶外伤导致的视神经挫伤及炎症的诊断也有重要意义.     

永存性原始玻璃体增生症的CT诊断

玻璃体； 增生； 体层摄影术，X线计算机     

泪腺窝眶缘骨孔固定泪腺治疗泪腺脱垂临床观察

目的:探讨泪腺窝眶缘骨孔固定泪腺治疗泪腺脱垂临床效果。方法:对21例42眼泪腺脱垂患者采用重睑切口,泪腺窝眶缘制作骨孔,缝线穿孔固定泪腺手术。术后随访3～36mo。结果:全组21例42眼,显效19例38眼,显效率90.5%,有效2例4眼,有效率9.5%,无效0例,总有效率100%。结论:泪腺窝眶缘骨孔固定泪腺能有效治疗泪腺脱垂,实现患者外观与功能的双重恢复。     

CT评估隧道式多孔聚乙烯植入材料修复眼眶骨折眶容积的改变

目的 探讨CT图像和计算机眼眶容积测算程序评估和预测隧道式多孔聚乙烯植入材料(MCI)修复大范围眼眶骨折后眼眶容积改变的临床意义.方法 收集单眼大范围眼眶骨折行MCI植入术且手术前、后检查资料完整患者16例,利用计算机Volume程序根据CT图像回顾性定量分析手术前、后眼眶容积的改变,使用Hertel突眼计测量手术前、后的眼球突出度.患者受伤到接受手术的平均时间为(17.4±10.0)d,平均随访时间为9个月.结果 手术后CT图像显示全部患者眼眶内前中段MCI位置良好.手术前伤眼眼眶容积[(28.16±4.32)cm3]与对侧健眼[(23.94±3.47)cm3]比较,差异有统计学意义(t=3.044,P＜0.01);手术后双眼眼眶容积比较,差异无统计学意义(t=0.069,P＞0.05).手术前、后眼眶容积的改变量与手术前眼球内陷程度相关(r=0.715,P＜0.01),缓解眼球内陷2 mm需手术整复眼眶容积2.86 cm3.结论 利用计算机客观测量眼眶容积可对创伤后眼眶骨折的严重程度和可能出现的眼球内陷进行预测.在大范围眼眶骨折导致眼眶容积改变时,在适应证范围内利用MCI行手术治疗是重建眼眶的有效方法,CT图像和计算机眼眶容积测算程序可为手术提供重要数据.     

爆裂性眼眶骨折早期和晚期临床及CT表现特征

目的观察爆裂性眼眶骨折早期与晚期的临床及CT表现特征。方法前瞻性研究。通过检查记录和随访观察,收集2012年6月至2013年8月来郑州大学第一附属医院就诊的39例爆裂性眼眶骨折患者的早期（受伤7 d内）和晚期（受伤34 d左右）临床表现及CT征象。回顾性总结其致伤原因主要为拳击伤18例（46%）,其次为车祸伤9例（23%）。结果39例患者早期视力下降13例（33%）,眶周软组织淤血肿胀38例（97%）,眼球凹陷≥2 mm有6例（15%）,眼球运动障碍及复视17例（44%）,眶下神经麻痹15例（38%）。晚期视力下降4例（10%）,无眶周软组织淤血,眼球凹陷≥2 mm 26例（67%）,眼球运动障碍及复视5例（13%）,眶下神经麻痹无好转2例（5%）。CT早期表现：折断端清晰锐利35例（90%）;眼外肌增粗36例（92%）,移位31例（79%）,边缘模糊不清33例（85%）;鼻窦积液30例（77%）,眶内积血积气5例（13%）。CT晚期表现：骨折断端模糊柔和28例（72%）;眼外肌肿胀36例（92%）,移位改善31例（79%）,边缘模糊不清2例（5%）,无眶内积气积血。结论爆裂性眼眶骨折早期具有眶周软组织淤血肿胀,骨折断端清晰锐利、眼外肌边缘模糊不清、鼻窦积液、眶内积血积气等特征;晚期具有眼球凹陷,骨折断端模糊不清、眼外肌边缘光滑等特征;掌握其特征对于眼眶爆裂性骨折的诊断及法医学鉴定、临床治疗具有重要意义。     

眶内非金属异物25例临床分析

目的 总结眶内非金属异物的临床特征及诊治方法.方法 回顾性系列病例研究.收集2002至2009年经手术证实的眶内非金属异物患者资料25例,总结临床表现、影像学征象、治疗与随访结果.结果 外伤性异物23例,包括:植物性异物11例,玻璃、油脂和石块各3例,塑料笔头2例,爆竹残渣1例.另2例为医源性异物.特征性临床表现为眶周皮肤或结膜瘘道,共11例,发生率为44%,以植物性异物最为多见.CT征象因异物性质不同而各异.植物性异物在外伤早期呈低密度,随时间延长密度逐渐增高,压缩窗宽,异物显示更加清晰.油脂异物表现为与脂肪相近的低密度,石块和玻璃表现为高密度块影.植物性异物在MRI的T1和T2加权像均呈低信号,周围的脓液在T2加权像呈环形高信号影,异物周围的炎性组织强化明显.油脂异物在T1和T2加权像均呈高信号,脂肪抑制显像呈低信号.所有患者均在全身麻醉下接受眶内异物清除术,均经一次手术清除全部异物及周围腐烂组织,感染伤口一期不予缝合.术后半年随访,伤口愈合良好,症状改善,未见与手术相关并发症.结论 眶内非金属异物种类较多,病情复杂各异,处置不当易眶内残留.CT为首选检查方法.正确认识病史及临床表现,运用恰当的手术技巧,彻底清除异物,预后良好.

Abstract：

Objective To evaluate the clinical features,diagnostic methods and treatment of intraorbital nonmetallic foreign body injuries. Methods In a retrospective study,the records of 25 consecutive cases with nonmetallic foreign bodies in the orbit confirmed by surgery were analyzed with special attention to the types of injury,history,clinical manifestations,imaging findings,treatment and follow-up results. Results Among 25 cases with nonmetallic foreign bodies,23 cases were caused by trauma,including 11 cases with wooden bodies,3 cases with glass,grease,or stone,2 cases with plastic pen point,and one case with firecrackers. The remaining two cases had iatrogenic foreign bodies. The distinctive clinical manifestation was the periorbital fistula recorded in 11 (44%) cases,mostly in patients with wooden foreign bodies. The CT findings were different in various foreign bodies. The wooden foreign bodies showed low density in the acute stage and the density increased gradually from the acute to the chronic stage. CT images with lower windows could distinguish a wooden foreign body better. The grease was seen as low density mimicking orbital fat on CT. The stone or glass showed as masses with high density. Wooden foreign bodies displayed low signals on both MRI T1- and T2-weighted images. The surrounding pus was seen as a ring with high signal on T2-weighted images. The inflammatory infiltration showed marked enhancement. The grease displayed high signal on both T1- and T2-weighted images and showed lower signal than that of the fat. All patients underwent surgical removal of retained foreign bodies and the surrounding decomposed tissues. The infected wounds were not sutured at one stage operation. After follow-up for 6 months,all wounds healed normally and all patients recovered well No complications were encountered.Conclusions There are various types of intraorbital nonmetallic foreign bodies. The clinical manifestations of these different foreign bodies are complex. CT is the preferred examination for this condition. With the combination of correct diagnosis,proper surgical skills,and complete removal of foreign bodies and surrounding decomposed tissues,nonmetallic foreign bodies can be treated efficiently.     

泪腺上皮性肿瘤的手术前影像学检查

目的 探讨泪腺上皮性肿瘤的临床特征及手术前影像学检查的特点.方法 回顾分析住院手术的泪腺上皮性肿瘤39例（39眼）,总结其临床特征、术前影像学检查特点.结果 良性泪腺上皮性肿瘤多表现为眼眶外上方硬性肿物,无压痛.而恶性泪腺上皮性肿瘤生长较快,疼痛较明显,常伴有视力下降及复视.良性及恶性肿瘤均有明显的眼球突出、眼球运动障碍、眼底改变、上睑下垂等表现.影像学上良性上皮性肿瘤形状规则,边界清楚,可伴有泪腺窝凹陷加重.恶性上皮性肿瘤形状不规则,边界不清,可伴有骨质破坏、肿瘤转移.结论 泪腺上皮性肿瘤具有比较典型的临床特征,可通过临床特征进行初步诊断.影像学检查对肿瘤的鉴别诊断有重要价值.     

泪腺病变的CT分析

目的探讨不同泪腺病变的CT表现,提高泪腺病变的诊断水平。方法20例23眼泪腺病变患者,比较分析其CT表现特点。结果10例11眼泪腺炎性假瘤表现为泪腺增大,与周围结构如眼环分界不清,部分边缘锐利,其中1例伴有外直肌及上直肌增厚。1例1眼泪腺淋巴细胞反应性增生表现为右侧泪腺体积增大,边界清楚。5例5眼泪腺混合瘤,主要表现为泪腺区类圆形软组织肿块,密度均匀。2例4眼良性淋巴上皮性病变表现为对称性双侧泪腺弥漫性肿大,与周围组织分界清楚。2例2眼泪腺癌表现为眼眶外上方软组织肿块影,侵犯邻近组织结构并破坏眶壁骨质。结论根据CT表现特点,多数泪腺病变可明确诊断。     

泪腺良性淋巴上皮病变免疫组织化学研究

目的 通过研究9种单克隆抗体在泪腺良性淋巴上皮病变中的表达,探讨其免疫病理本质及发病机制,为临床治疗及预后提供理论依据.方法 使用CD4、CD8、CD21、CD34、CD45、CD68、IgG、IgG4和增殖细胞核抗原这9种分子的单克隆抗体,应用免疫组织化学染色SP法对25例泪腺良性淋巴上皮病变的石蜡标本进行免疫组织化学染色.结果 B淋巴细胞表面抗原(CD21)、T淋巴细胞表面抗原(CD4、CD8和CD45)、黏附分子CD34及IgG在25例样本中均呈阳性表达,巨噬细胞表面抗原CD68、增殖细胞核抗原和IgG4这3种分子在25例样本中均有一定比例的阳性表达,表达率分别为12％、8％和80％.结论 泪腺良性淋巴上皮病变是一种主要以B淋巴细胞和T淋巴细胞激活为主要病理免疫基础的疾病,绝大多数属于IgG4相关性疾病的范畴,同时有发生恶变的潜能,临床治疗后的密切随访很有必要.     

泪腺肿瘤的影像学表现

泪腺肿瘤在眼眶病中构成比较大,患者发病年龄跨度大,无明显性别差异。临床表现主要为眼球突出、鼻侧移位,眼球运动受限,泪腺区可扪及肿物等。了解泪腺肿瘤影像学特点有助于病情预后的判断及手术方案设计。本文对属于泪腺上皮性肿瘤的多形性腺瘤、腺样囊性癌、粘液表皮癌、嗜酸性细胞癌、泪腺腺癌、泪腺上皮囊肿,以及属于非上皮性肿瘤的泪腺炎性假瘤、泪腺良性淋巴上皮病变、泪腺淋巴瘤及多发性骨髓瘤等影像学特点进行总结,旨在为泪腺肿瘤的诊治提供帮助。（国际眼科纵览,2016,40：196-200）     

Benign peripheral nerve sheath tumors (neurofibromas) of the lacrimal gland

Two patients, a 43-year-old woman and a 62-year-old man, developed benign peripheral nerve sheath tumors (neurofibromas) of the lacrimal gland, in the former case of the deep orbital lobe, and in the latter of the palpebral lobe. A neurogenic tumor was not seriously considered clinically in either case, because of the paucity of previous reports on the occurrence of neural tumors in the lacrimal fossa region. Instead, in the first case a benign mixed tumor was considered the most likely clinical diagnosis, whereas in the second the coexistence of a swelling in the parotid gland raised the possibilities of a lymphoid tumor or a leukemia. Due to unusual light microscopic features, transmission electron microscopy was required to secure unequivocal diagnoses. In the orbital lobe tumor, an encapsulated spindle cell proliferation without nuclear palisading but with focal areas of myxoid change suggested either a cellular benign mixed tumor or a schwannoma. The palpebral lobe lesion displayed a myxoid spindle cell proliferation that had splayed apart the ducts and acinae of the lacrimal gland, to impart the overall appearance of a benign mixed tumor. The ducts, however, were multilaminar rather than possessing the usual double cellular layer seen in classical benign mixed tumors, and the glandular units contained zymogen granules, which are typically not seen in benign mixed tumors. Electron microscopy disclosed in both lesions the presence of interrupted basement membrane material partially surrounding the tumor cells, long spacing collagen (banded basement membrane material), and poorly developed desmosomes, features compatible with a neural tumor. Neither myofilaments, tonofilaments, nor ductal-type granules sometimes observed in benign mixed tumors were discovered. The tumor cells in these cases therefore failed to demonstrate clear-cut Schwann cell characteristics (eg, continuous basement membranes, pseudo-mesaxons, tangles of cell processes), and more closely resembled perineural cells that have been described in ultrastructural studies of peripheral nerve tumors including neurofibromas of other sites.     

Correlation of computed tomographic and histopathologic features in malignant transformation of benign mixed tumor of lacrimal gland

A 65-year-old man had painless progressive proptosis of five years' duration in his left eye. Sudden increase of the proptosis required a lateral canthotomy. A lateral orbitotomy was performed and a large, encapsulated, globoid mass was totally excised. Histopathologic diagnosis was adenoid cystic carcinoma arising in and surrounding a benign mixed tumor of the lacrimal gland. The computerized tomographic features correlated quite accurately with the gross appearance and histopathologic findings observed in the lacrimal gland mass. The authors discuss the clinical and radiographic features that should alert the clinician to the possibility of malignant transformation in a benign mixed tumor of the lacrimal gland.     

B cell receptor signaling pathway involved in benign lymphoepithelial lesions of the lacrimal gland

AIM: To detect the expression of B cell receptor signaling pathway (BCRSP) in lacrimal gland benign lymphoepithelial lesions (LGBLEL). METHODS: Gene microarray was used to compare whole-genome expression in lacrimal gland tissues from LGBLEL patients to tissues from orbital cavernous hemangioma (control tissues). Expression of BCRSP was confirmed by polymerase chain reaction (PCR) and immunohistochemistry. RESULTS: The expression of 22 genes of the BCRSP increased significantly in LGBLEL patients. PCR analysis showed that CD22, CR2, and BTK were all highly expressed in LGBLEL tissues. Immunohistochemical analysis showed that CR2 protein was present in LGBLEL, but CD22 and BTK proteins were negative. CR2, CD22, and BTK were not observed in the orbital cavernous hemangiomas with either PCR or immunohistochemistry. CONCLUSION: BCRSP might be involved in the pathogenesis of LGBLEL.     

Association of the macrophage migration inhibitory factor promoter polymorphisms with benign lymphoepithelial lesion of lacrimal gland

AIM: To identify the association of the macrophage migration inhibitory factor (MIF) gene polymorphism with the susceptibility of benign lymphoepithelial lesions (BLEL) of the lacrimal gland. METHODS: A total of 40 BLEL of lacrimal gland cases were matched with 40 healthy subjects (HS). Extraction the plasma and whole blood DNA of patients of lacrimal gland BLEL and HS. Elisa and polymerase chain reaction was used to determine in plasma contents of MIF and MIF gene SNP-173G>C and STR -794 CATT(5-8) polymorphism, respectively. RESULTS: The MIF levels in plasma were significantly higher in patients with lacrimal gland BLEL versus HS (P<0.001). The -173 G>C MIF polymorphism was significantly associated with lacrimal gland BLEL, with a significantly higher frequency of the C allele in lacrimal gland BLEL patients compared with HS (OR=2.38, 95% CI=1.07-5.31, P=0.032), and the -173 C/x is more frequent in patients than in HS, P=0.037. Besides, we found that the carriage rate of the MIF -173C/x is associated with higher plasma levels of MIF in the BLEL of lacrimal gland. CONCLUSION: MIF -173G/C variants play an insidious role in susceptibility of BLEL of lacrimal gland. Otherwise, there is no statistically significant correlation exists between MIF-794 CATT (5-8) and BLEL of lacrimal gland.     

补体经典途径在泪腺良性淋巴上皮病变发生中的作用

目的：分析补体系统(CS)及其经典途径在泪腺良性淋巴上皮病变(LGBLEL)发病机制中的作用。

方法：采集LGBLEL患者和眼眶海绵状血管瘤(CH)患者的病变组织标本,使用蛋白质组学方法分析差异蛋白,而后采用逆转录-聚合酶链反应(RT-PCR)、免疫组织化学染色(IHC)和蛋白质印迹法(Western Blotting)验证CS信号通路中差异蛋白表达的变化,明确其在LGBLEL发病机制中的作用。

结果：蛋白质组学分析结果表明,相对于眼眶CH患者,LGBLEL患者病变泪腺组织中CS信号通路重要蛋白C3、C5、C9、C1q等表达均发生改变; RT-PCR检测结果显示,与眼眶CH患者相比,LGBLEL患者病变泪腺组织中C1qA、C5、C9 mRNA表达升高; 免疫组织化学染色结果显示,与眼眶CH患者相比,LGBLEL患者病变泪腺组织中C1qA、C3、C5、C9表达明显增多; Western Blotting检测结果显示,与眼眶CH患者相比,LGBLEL患者病变泪腺组织中C1qA、C3、C9蛋白表达水平明显升高。

结论：CS参与LGBLEL的发病机制,其经典途径可能是其发挥作用的途径之一。